Client Contact Policy:
We need to be able to communicate regarding appointments, scheduling, and other service-related issues. You will need to provide a phone number, name of your cell phone service provider, and email address where you can receive messages related to appointment reminders, scheduling, and billing matters.
Cancellation Policy:
In the event that you are unable to attend your session, you must give 24-hour notice, or you will be responsible for a cancellation fee. On rare occasion, if there is determined to be an unavoidable emergency or unforeseeable event, such as illness, transportation failure, or significant family altering event, you may discuss this with me and I may consider waiving the fee if you call before your session and work to reschedule.
Additionally, I follow the Waterloo Community School district policy regarding weather related delays and cancellations. If school is cancelled or delayed due to weather conditions, the Center is typically closed at those times as well. You will be contacted personally if the Center needs to be closed for those, or other reasons, and we will do our best to reschedule when possible.
Insurance, Payment, and Private Pay Information:
Important steps to take before initial appointment:
- Locate your insurance card, you will need to provide me with information prior to your intake session and bring this with you to your first appointment.
- Contact your insurance provider so you are informed and aware of the coverage and potential costs. Any costs not covered by insurance are your responsibility. You will want to ask specifically about your mental health benefits, both for in-person and telehealth options, and any exclusions to those benefits. You will also want to ask about your deductible and if it needs to be met prior to services being covered. In addition, investigate if you have co-payments, coinsurance, if pre-approval is required from your primary care physician, and if there is a limit to the number of therapy sessions your plan will cover annually.
If I am not in-network with your current insurance provider, you can contact your insurer and ask what kind of coverage is offered for out-of-network services. It may be possible to receive prior-authorization or to have a portion of services paid if you call and ask.
You will need to know your co-pay and/or deductible information and are responsible for paying this at the time of service.
I am able to accept and process secure, electronic payments at the Center. I will also accept cash or check. Cash or check payments must be exact and are due at time of service. There is a fee of $25.00 for any returned checks.
I encourage families to look into using their health savings accounts (HSA) or flexible spending accounts (FSA) or for therapy if that is an option. It is your responsibility to make sure that mental health therapy services are covered by your HSA or FSA.
Please contact me directly if you are interested in discussing private pay services.
Patient Responsibility Definitions:
Deductible: An amount of money you must pay before your insurance pays anything related to your care. You will be asked to pay any outstanding deductible at the time of service, if applicable.
Co-payment: This is an amount set by your insurance company. The amount depends on your specific plan. It is to be paid at the time of service, if applicable. Please check with your insurance company for additional information.
Co-Insurance: A percentage set by your insurance plan that you must pay. For example, the insurance may pay 80% and the patient pays 20%. Please check with your insurance company for more information. You will be asked to pay any estimated co-insurance at the time of service, if applicable.
For information on what insurance is currently accepted, please call 319.888.1022 or email ari@cvceat.com
Billing Policy:
You are responsible for 100% of the costs of services not covered by insurance. You may choose to submit your receipt for services to your insurance for out-of-network benefits, but I do not deal directly with your insurance if I am not in network with them. If you will be using insurance and have a co-pay amount, you are responsible for paying that amount at the time of service. You may also elect to private pay for services if you so choose. Please see me to discuss private pay rates for services.
Electronic Data Storage:
I utilize a HIPAA compliant portal called SimplePractice for clinical record keeping and billing purposes. Their platform is HIPAA compliant. You can read more about SimplePractice at https://www.simplepractice.com.
Good Faith Estimate*
Under the Federal No Surprises Act (H.R. 133 – effective January 1, 2022), you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
Note: A Good Faith Estimate is for your awareness only. It does NOT involve you needing to make any type of commitment to the length or frequency of therapy sessions.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the Help Desk at 1-800-985-3059 for more information. TTY users can call 1-800-985-3059.
*Disclaimer: This legislation is still being interpreted involving mental health professionals and the above statement is in effort to provide what is currently believed to be important and required to share with both prospective and current clients. This page may be updated as more information evolves involving this new statute.
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
(OMB Control Number: 0938-1401)
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgicalcenter, you are protected from surprise billing or balance billing.
What is “balance billing”(sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care – like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivistservices. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you unless you givewritten consent and give up your protections.
You’re never required to give up your protection from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
- You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilitiesdirectly.
- Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (priorauthorization).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductibleand out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact: you may contact: 1-800-985-3059 to submit a complaint regarding potential violations of the No Surprise Act.
Visit https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for more information about your rights under Federal law.
